Stephanie Botti
Pittsburgh,PA
Summary
Certified Clinical Documentation Specialist and Clinical Auditor/Analyst facilitating positive changes to documentation through close collaboration with healthcare providers and administrators. Analysis-oriented professional with proficiency in multiple EHR platforms, and exemplary judgement and critical thinking skills. Dynamic leader committed to finding ways to improve workflows and processes that save time and money.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Clinical Auditor/Analyst
UPMC Health Plan
05.2019 - Current
- Utilizing standard coding guidelines and principles, coding clinics, government regulations and protocols to verify the appropriate ICD-10-CM diagnosis code is correctly assigned by internal or external providers, vendors or staff
- Ensuring the member's HCC(s) are supported within the member medical records for the specified audit period or review time frame
- Participating in government Risk Adjustment Data Validation audits (RADV) conducting research of internal systems verifying member HCC(s) selected for audit meet ICD-10-CM, AHA coding clinics and government submission criteria
- Daily application of knowledge of Medicare and Affordable Care Act RADV audits, protocols, guidelines, record submission, audit tools and websites
- Review and analyze medical records utilizing knowledge of anatomy, physiology, medical terminology, pathology and associated clinical processes related to the appropriateness of coding, clinical care, and documentation
- Accurately review HCC diagnosis codes and apply the appropriate inpatient or outpatient coding guidelines, AHA coding clinics, ICD-10-CM or government regulations
- Review provider coding/billing trends, and government audit outcomes to identified HCC coding improvement and opportunities
- Work in collaboration with adjacent departments to facilitate the resolution of coding issues, focused review outcomes, government audit outcomes, or ad hoc reviews
- Provide a clinical opinion for special projects or various issues including appropriate diagnosis coding, provider coding trends or identify areas of provider documentation improvements
- Proficient with Microsoft office products: Word, Excel, PowerPoint, Teams, and One Note
- Provide onboarding training for new staff
- Proficient with Epic, Cerner, Allscripts, Mckesson HPF, CCHIE, Edifecs, and Document Viewer
- Participate and lead coding vetting conversation using active listening and open-ended conversation
- Abstract necessary medical records from physician office and other provider facilities.
Clinical Documentation Improvement Program Supervisor
St. Clair Hospital
01.2013 - 01.2019
- Monitoring and review of clinical documentation program and clinical documentation specialist staff, identifying and implementing quality improvement opportunities through program data analytics, monitoring staff productivity, interviewing, training, and developing staff, providing ongoing physician education for clinical documentation, assistance with and writing of appeal letters for inpatient insurance plan denials, development and approval of departmental budget, chair of clinical documentation steering meetings
Clinical Documentation Specialist
St. Clair Hospital
- Performing admission/continued stay reviews for completeness and accuracy for severity of illness and quality using Clinical Documentation Improvement (CDI) Program and documentation strategies, Formulating CDI severity worksheets and clinical clarifications for inpatients, sending/presenting opportunities for improved documentation compliance to physicians, nurse practitioners and other medical staff, Processing discharges by updating the DRG Worksheet/EPIC EHR to reflect any changes in status, procedures/treatments to finalize diagnoses, Completing DRG reconciliation/adjustment in collaboration with HIM coding department, Educating internal stakeholders on compliant documentation opportunities, coding and reimbursement issues, and performance improvement strategies, Participated in Task Force meetings and collaborated with HIM coding staff on a regular basis to resolve variances with DRG assignments and other coding issues
Emergency Department Travel Nurse
AMN Healthcare
01.2010 - 01.2013
- Multiple travel assignments across the country in both community and trauma certified ED’s, worked in Dallas, TX, Lewes, DE, Palm Springs, CA, and New Port Richey, FL
Registered Nurse
UPMC Health System
01.2005 - 01.2010
- Staff nurse at Level I Trauma and Burn Center, Certified Stroke Center, performing full physical assessments, medication administration, triage assessments, cardiac monitoring, procedures including IV catheterization, ECG, nasogastric tube insertion, urinary catheterization and many other nursing procedures, charge nurse duties coordinating flow of the department and supervising staff, performed psychiatric and detoxification assessments for admission criteria to acute care inpatient facility, coordinating patient care and obtaining authorization for treatment through pre-certification process
Education
Bachelor of Science of Nursing -
California University of Pennsylvania
California, PA01.2015
Associate of Science of Nursing -
Community College of Allegheny County
West Mifflin, PA01.2005
Skills
- Certified Clinical Documentation Specialist
- Certified Risk Adjustment Coder
- Certified Professional Coder
- Experience with Risk Adjustment Data Validation Audits (RADV)
- Knowledge of multiple lines of business (Medicare, ACA, Commercial, etc) and application of CMS guidelines
- Experience with revenue cycles for hospital and payer settings
- Expertise in both HCC and DRG payment methodologies
- Report Generation with data analysis and trending
- Proficient in Microsoft Office products
- Skilled in Epic, Cerner, Allscripts, McKesson HPF, CCHIE, Edifecs, Document Viewer
Accomplishments
Highlighted in the January/February 2024 ACDIS CDI Journal in "CDI specialized roles: A unique boutique of hats" article
Certification
- Certified Clinical Documentation Specialist
- Certified Risk Adjustment Coder
- Certified Professional Coder
- Toyota Lean Process Trained
- HIPAA
- Basic Arrhythmia
- Clinical Coach
- Disaster Training
Awards
- Cameo of Caring Nominee 2007
- Excellence in Practice Award 2008
Affiliations
- ACDIS
- AAPC
Timeline
Clinical Auditor/Analyst
UPMC Health Plan
05.2019 - Current
Clinical Documentation Improvement Program Supervisor
St. Clair Hospital
01.2013 - 01.2019
Emergency Department Travel Nurse
AMN Healthcare
01.2010 - 01.2013
Registered Nurse
UPMC Health System
01.2005 - 01.2010
Clinical Documentation Specialist
St. Clair Hospital
Bachelor of Science of Nursing -
California University of Pennsylvania
Associate of Science of Nursing -
Community College of Allegheny County
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